Simulation technology propels education at UB School of Nursing

Published January 17, 2024

At the UB School of Nursing, simulation technology is changing the way students are being prepared to face real-world scenarios in the field of nursing.  

Kelly Foltz-Ramos, PhD, Director of Simulation and Assistant Professor at the University of Buffalo School of Nursing, always had an eye for technology.

Foltz-Ramos’ first introduction into simulation technology was through her first day on the job as a nurse educator in the clinical setting.

“My new employer told me that they had purchased two patient simulators,” Foltz-Ramos added. “So, my directive was to take them out of the boxes, learn how to use them, and start a simulation program. And so, I did.”

Foltz-Ramos joined UB in 2012 as the Clinical Laboratory Coordinator and Assistant Professor. She became the Director of Simulation and an Assistant Professor for the UB School of Nursing in 2018.  

High fidelity hybrid simulation



Sarah Zamer - IT Communications Specialist.

Sarah Zamer joined UB in January 2023 as an IT Communications Specialist for UBIT, focusing on video production. Prior to UB, she spent over a decade in the television news industry as a Director/Producer.

 A Buffalo native, Sarah enjoys spending time in Western New York with her family and friends. She also enjoys traveling, bowling, and the occasional round of golf.



The UB School of Nursing’s goal with simulation is to be as high fidelity as possible. 

“When we talk about fidelity in the context of health care simulation, we are really talking about how true to life it is,” Foltz-Ramos said. 

For many of their scenarios, the UB School of Nursing incorporates hybrid simulation, which is a mix of using real actors and wearable technology. One of those forms of wearable technology is a Simshirt. 

“When we use the Simshirt, we can make a healthy actor have any heart, lung, or bowel sounds that will portray the condition that we have in the scenario,” Foltz-Ramos said. “It has built in electronics that we control through software.” 

Another form of hybrid technology offered at the UB School of Nursing is the MamaNatalie birthing simulator which creates realistic birthing scenarios for students. 

According to Jessica Pham, a UB Nursing student, “Compared to a mannequin, it was just different because you had to think differently in terms of how to maneuver and what you’re going to be expecting.” “So, it just prepared me for what to expect in real life." 

Patient simulator technology

There are scenarios for nursing students where the UB School of Nursing will use patient simulator manikins, specifically for scenarios involving children, CPR, or chest compressions, and even death. 

“This is such a key part of the curriculum, because it’s not likely that they’re going to see a patient death in their clinical experience,” added Foltz-Ramos. “This gives them the opportunity to start developing healthy coping skills so they can be prepared when they experience death in the clinical setting.” 

Control room software for real-world scenarios

Graduate assistants in the DNP program running control room software at the UB School of Nursing.

Whether it’s hybrid or patient simulator technology, the UB School of Nursing employs various software platforms to change vital signs, heart or lung sounds, and patient behavior. They also use educational electronic health records to make real time changes to medical records if there are new orders given during health care scenarios for students. 

“We incorporate various software platforms, and they are run by our graduate assistants who are all practicing registered nurses in our DNP program,” Foltz-Ramos said. 

The UB School of Nursing also runs an audio-visual system so that they can stream and record scenarios. This allows students to observe patient scenarios and debrief afterwards. 

Virtual reality in nursing simulation

A nursing student demonstrates VR technology at the UB School of Nursing.

The next step in simulation technology at the UB School of Nursing involves virtual reality headsets to create realistic environments for students. 

“We recently received funding from HRSA to start the REACHvr Program, which is going to teach our students about health care in rural and underserved areas,” added Foltz-Ramos. “It makes sense. We are an urban campus in an urban setting. In virtual reality, we can create a rural clinic for the students.” 

“It’s so amazing how they designed it that I feel like when we are doing it as a virtual simulation, it’s going to be exactly like what you are going to be doing in real life,” Pham said. 

Advancing simulation technology to make a difference

With simulation technology, the UB School of Nursing is striving to make a difference in the nursing field. 

“Recently New York State passed legislation to allow simulation to be used for up to 30% of clinical time for our nursing students,” added Foltz-Ramos. “We’re really trying to increase simulation to increase enrollment and put more nurses out into the workforce.” 

As to what’s next for the future of simulation technology in nursing? Foltz-Ramos believes it will come from artificial intelligence. 

“I think a big thing in the future is going to be artificial intelligence, because right now we use virtual reality, but we still need critical input from the instructor in how the patient responds,” said Foltz-Ramos. Improving artificial intelligence will allow that to happen automatically and it will really make it a much better experience for the students.”